Effectiveness of Pressure Ulcer Protocols with the Braden Scale for Elderly Patients in the Intensive Care Unit: A Systematic Review

Each year, approximately 3 million people in the United States develop a pressure ulcer. Although a preventable complication, pressure ulcers are among the top 5 adverse outcomes in the acute care setting with the prevalence as high as 42% in the intensive care unit (ICU). The purpose of this systematic review was to evaluate the inclusion of the Braden Scale as part of a multicomponent pressure ulcer intervention protocol, or care bundle, to identify geriatric patients hospitalized in the ICU who were at risk for pressure ulcers. The Cochrane protocol guided this review; findings were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Through a structured search strategy in 6 electronic databases, 409 studies were reviewed, of which 11 studies were analyzed and the data included in a literature review matrix for synthesis. Four key findings emerged from the data analysis: effective pressure ulcer prevention programs use a risk assessment, daily reassessment of risk, daily skin inspections, moisture removal strategies, nutritional support and hydration, and offloading pressure; the Braden Scale is effective in detecting pressure ulcer risk in the ICU; an evidence-based bundle is effective in preventing pressure ulcer development; and decreased risk for pressure ulcer development increases patient safety, improves quality of care, and reduces the overall cost of care. The findings from this project can result in positive change by providing the evidence to guide improvements in pressure ulcer protocols to increase the quality of care and decrease the incidence of pressure ulcers in the ICU